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. 2022 Mar 15;4(1):85-94.
doi: 10.1016/j.jaccao.2022.01.100. eCollection 2022 Mar.

Incident Cardiovascular Disease Among Adults With Cancer: A Population-Based Cohort Study

D Ian Paterson  1 , Natasha Wiebe  1 , Winson Y Cheung  2 , John R Mackey  3 , Edith Pituskin  4 , Anthony Reiman  5 , Marcello Tonelli  6
Affiliations

Incident Cardiovascular Disease Among Adults With Cancer: A Population-Based Cohort Study

D Ian Paterson et al. JACC CardioOncol. .

Abstract

Background: Patients with cancer and cancer survivors are at increased risk for incident heart failure, but there are conflicting data on the long-term risk for other cardiovascular events and how such risk may vary by cancer site.

Objectives: The aim of this study was to determine the impact of a new cancer diagnosis on the risk for fatal and nonfatal cardiovascular events.

Methods: Using administrative health care databases, a population-based retrospective cohort study was conducted among 4,519,243 adults residing in Alberta, Canada, from April 2007 to December 2018. Participants with new cancer diagnoses during the study period were compared with those without cancer with respect to risk for subsequent cardiovascular events (cardiovascular mortality, myocardial infarction, stroke, heart failure, and pulmonary embolism) using time-to-event survival models after adjusting for sociodemographic data and comorbidities.

Results: A total of 224,016 participants with new cancer diagnoses were identified, as well as 73,360 cardiovascular deaths and 470,481 nonfatal cardiovascular events during a median follow-up period of 11.8 years. After adjustment, participants with cancer had HRs of 1.33 (95% CI: 1.29-1.37) for cardiovascular mortality, 1.01 (95% CI: 0.97-1.05) for myocardial infarction, 1.44 (95% CI: 1.41-1.47) for stroke, 1.62 (95% CI: 1.59-1.65) for heart failure, and 3.43 (95% CI: 3.37-3.50) for pulmonary embolism, compared with participants without cancer. Cardiovascular risk was highest for patients with genitourinary, gastrointestinal, thoracic, nervous system and hematologic malignancies.

Conclusions: A new cancer diagnosis is independently associated with a significantly increased risk for cardiovascular death and nonfatal morbidity regardless of cancer site. These findings highlight the need for a collaborative approach to health care for patients with cancer and cancer survivors.

Keywords: AMI, acute myocardial infarction; CV, cardiovascular; MI, myocardial infarction; SEER, Surveillance, Epidemiology, and End Results; cancer survivorship; coronary artery disease; epidemiology; heart failure.

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Conflict of interest statement

Research support was provided (to Dr Tonelli) by a foundation grant from the Canadian Institutes of Health Research. Dr Tonelli was supported by the David Freeze Chair in Health Services Research at the University of Calgary. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the paper; or decision to submit the manuscript for publication. This study is based in part by data provided by Alberta Health and Alberta Health Services. The interpretation and conclusions contained herein are those of the researchers and do not represent the views of the government of Alberta or Alberta Health Services. Neither the government of Alberta nor Alberta Health or Alberta Health Services expresses any opinion in relation to this study. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

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Graphical abstract
Central Illustration
Central Illustration
Cardiovascular Risk by Time From Cancer Diagnosis In this population-based cohort study of 4,519,243 adults, we determined that a new cancer diagnosis was independently associated with a significantly higher early and persistent risk for cardiovascular death, pulmonary embolism, heart failure, stroke, and acute myocardial infarction. The risk for cardiovascular death, pulmonary embolism, and heart failure was attenuated but remained significantly elevated after 10 years of follow-up. The width of the lines shows the 95% CI. Specific point and interval estimates are available in Supplemental Table 4.
See this image and copyright information in PMC

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